How radicals emptied the American mental hospitals, and the chaos that resulted.

The homeless problem in many American cities is partly due to the emptying of the mental hospitals due to laws passed since the 1960s. The history of how these laws came about, and the damage they caused is covered in several chapters of the book “Madness in the Streets” by Rael Isaac and Virginia Armat. In a recent article, libertarian John Stossel writes:

I’ve never seen slums in Africa, but I’ve seen them in Haiti and India. What I saw in San Francisco looked similar. As one local resident put it, “There’s shit everywhere. It’s just a mess out here.” There’s also lots of mental illness. One man told us, “Vampires are real. I’m paranoid as hell.” San Francisco authorities mostly leave the mentally ill to fend for themselves on the street. Other vagrants complain about them. “They make it bad for people like us that hang out with a sign,” one beggar told us.

The way the laws came about is a cautionary tale of much of what is wrong in America. The philosophy behind the laws was inspired by the idea that either mental illness did not exist at all, or that drugs and other treatments were harmful. There was an image of mental hospitals being a prison – a prison where people were committed without having done anything wrong. Some of the advocacy groups that pressed for these laws received government funds, since in the U.S. an organization that claims to do good for some disadvantaged group can often get funds for its work.

In 1967 California passed the Lanterman-Petris-Short act. This act had been pushed by a coalition of believers in community psychiatry, antipsychiatry and fiscal savings. It relied on a study which was based mainly on sources which saw hospitals as the cause of mental illness. One result of this act was that patients could be not be held involuntarily for more than 17 days, though afterwards, for gravely disabled patients, conservators could be appointed. By 1973, the public was so alarmed at the results that Governor Ronald Reagan had to abandon his plan to close all state mental hospitals (his original plan did allow for small units for the criminally insane).

In 1972 Milwaukee Legal Services filed a successful class action suit under the Civil Rights act, and obtained for mental patients the same protections as for criminal suspects, including the right to remain silent and the right to a jury trial. So now, instead of the 17 days involuntary confinement of California, in Wisconsin you had in practice only 72 hours. Following the example of Wisconsin, other states also applied criminal statutes to mental illness.

A lawyer who did believe in mental illness, Morton Birnbaum, successfully pushed for a ‘right to treatment’ but this was derailed by anti-psychiatry lawyers such as Bruce Ennis, who realized that by demanding impossibly high standards states would have to discharge many of their patients. As an example, when the state of Alabama reduced taxes, it no longer could staff the state mental hospital, which ended up with one psychiatrist for 5,000 patients. Food, clothing and physical plant were woefully inadequate. The judge however went overboard and defined the needs of the patients as including social workers, religious chaplains, dieticians and more. This was beyond the reach of any practical budget, and a dismayed Birnbaum bowed out of the suit. Instead he tried to combat the Medicaid exclusion (Medicaid would not fund mental illness treatment for State Hospital patients). Birnbaum lost this new suit, but the original suit succeeded in emptying out Alabama’s mental hospitals.

Due to a “right to treatment” case brought by a patient named Kenneth Donaldson, in 1974 a court passed a ruling that meant that a psychiatrist was liable for a fine for not treating Donaldson, though Donaldson had rejected all treatment since he did not believe he was ill. From now on, for psychiatrists it was far easier to release patients than to run the risk of damage suits.

Now came the right to REFUSE treatment. By the mid-1970s, the statues of virtually all states provided that patients were legally competent, and just as a cancer patient could refuse chemotherapy, a mental patient could refuse any treatment prescribed for him. In 1980, in Massachusetts, a judge ruled that the parent of a very sick and violent patient named Richard Roe could not make the decision whether Richard could take medications, because he was not as detached as a court would be. As the authors note: it was precisely the lack of detachment that made the father a desirable guardian – he cared about his son’s interests.

The results of these, and other developments that I have not included but the authors have, was mostly very bad.

Many mentally ill patients ended up in real prisons, as opposed to mental hospitals, and they ended up with situations such as one young man named Bobby who was gang-raped by other inmates. The local Sheriff said that Bobby needed “professional care, and he needs it constantly. But we don’t have that…” It was in the name of preserving Bobby’s “liberty” that the mental health bar denied him that care.

Many mental patients don’t believe they are sick. If you believe that you are being pursued by creatures from outer space, you will be indignant when you are told that you are crazy.

The authors write:

Today the family is the institution. It is estimated that 800,000 individuals suffering from schizophrenia and manic-depressive illness now live with their families, mostly their parents. As psychiatrist John Talbott observes, families have become the doctors, the nurses, and the social workers. But if the family has become, as one article put it bluntly, “the replacement for the ward staff” it is a staff without shifts, without backup, without the ability to enforce daily routines or medication compliance.

Don Richardson, former president of the family organization, the National Alliance for the Mentally Ill, summed up the plight of many families: “You feel like you are the jailer and you feel you are also in jail.” Accordng to Dan Weisburd, who headed California’s Alliance for the Mentally Ill: “Most of the families are destroyed. If you look at the divorce figures I’m sure they’re much higher than in the population at large.”

One mother described her son:

He has been brutalized by the police in North Carolina; picked up unconscious and his life saved by the police in Texas and later in Nevada; hit on the head with baseball bats by local people in Virginia; put in jail for sleeping on the beach in Massachusetts and then released from the hospital on the condition that he leave the state; wandered through Nevada, Utah, and California without money; lived for months in summer and then winter rains on the streets in Washington state; starved in Florida and also the hospital…(he does not eat when he is off meds).

The current situation has been summed up by psychiatrist Darold Teffert:

“What kind of “freedom” is it to be wandering the streets severely mentally ill, deteriorating, and getting warmth from a steel grate or food from a garbage can? That’s not freedom; that’s abandonment. And what kind of “liberty” it is to be jailed for disorderly conduct, crazed and delusional, because that is all the law will allow, instead of being hospitalized, treated, and released? That’s not liberty, that’s imprisonment for the crime of being sick. And what kind of twisted “right” is it to stab or shoot to death yourself or some innocent bystander while in a psychotic frenzy, directed by terrifying voices from a disordered and disabled mind?…

I’ll just give a few of my own thoughts here. It is true that psychiatry is somewhat of an art, and not a science. How the drugs that psychiatrists prescribe really work is not known, because how the brain works is not known. And its not just treatment – misdiagnosis is also possible.

On the other hand the protections that were built in for the accused in our courts assume the accused is competent, and there is obviously a danger in having a court decide you are not competent, and that therefore you have no rights to counsel and to give your side of the story. So the law has to be augmented by common sense. If you have a false theory, as some advocates do, that the brain cannot be ill, or at least the mind cannot be ill, you will push for laws that make no sense.

I’ll end with an observation about a libertarian, John Stossel, who I quoted at the beginning. Stossel believes that marijuana should be legalized, because: “Adults should have the right to make their own decisions about what to put in their own bodies.” There’s almost a contradiction here though – the mental patients who he sees on the streets of San Francisco have often made that decision – to not put medications into their bodies – which is why they are homeless!

Denying rights in order to liberate people to have rights is an odd concept, but we do apply that principle with children – we don’t let young children go outside without supervision, for instance. We have to accept that the mentally ill are also in some cases unable to make necessary judgements.

Rael Isaac says that little has changed since 30 years ago, when the book was published. “All the faults of the system (if you can call it a system) that came out of the mental health bar’s victories remain. Jails and prisons have become holding pens for the mentally ill. The streets are full of them, some commit acts of violence. No-one seems to have learned anything.”

Sources: John Stossel: San Francisco has become the slum by the bay — Bad laws cause city’s homeless crisisMadness in the Streets – Rael Jean Isaac and Virginia C Armat (1990)